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Cognitive Analytic Therapy in the treatment of eating disorders

Over the last two decades, Cognitive Analytic Therapy has been used increasingly widely in the treatment of eating disorders. There are currently two small RCT's in the literature and an audit is in press. In Treasure et al’s (1995) pilot study of outpatients with Anorexia Nervosa, those who were randomized to CAT reported significantly greater subjective improvement at 1 year follow up than those allocated to Educational Behaviour Therapy. Dare et al’s large scale (2001) study comparing CAT with family therapy, psychodynamic psychotherapy and supportive therapy showed there were broad similarities between CAT, psychodynamic therapy and family therapy in the treatment of Anorexia. Tanner and Carolan’s (2009; in press) audit of 100 patients with a diagnosis of either Anorexia Nervosa or Bulimia Nervosa treated with CAT, demonstrated significant improvement in symptoms in both groups at the end of therapy.

Why choose CAT?

CAT can be used to treat the spectrum of eating disorders from Anorexia Nervosa to Bulimia Nervosa, EDNOS (Eating disorders not otherwise specified) to Binge Eating Disorder because eating disordered behaviour can be tackled alongside underlying intra and interpersonal factors maintaining the eating difficulties. Treasure and Ward (1997) posit that the collaborative stance of CAT helps to diffuse the battles commonly encountered in a population re-enacting a controlling reciprocal role, thus facilitating engagement of ambivalent patients who have often failed to engage in other more prescriptive therapies. It is precisely CAT’s ability to meet patient’s “where they are at” and develop a shared understanding of past and current difficulties which makes it a favourable therapeutic choice for patients who often value their symptoms, whether it be the affect management afforded by restricting, bingeing or purging or the care recruited by the emaciated physical state in Anorexia Nervosa.

CAT is becoming more popular in the treatment of eating disorders across primary, secondary and tertiary services as co-morbid personality difficulties and psychiatric symptoms such as substance misuse, depression and self harm, prevalent in the eating disorders population can be addressed by the broad focus of CAT (Tanner and Connan, 2003) where they are often seen as exclusion criteria in other forms of therapy.

CAT can be used with adolescents and adults with eating disorders and has the advantage of being flexible enough to be used with individuals, groups and families.

Feedback from an anonymous service user who has had CAT for the treatment of their Anorexia Nervosa:

“Cognitive analytic therapy helped me to link my symptoms around food with deeper issues around how I relate to others in my personal life. It always felt like it was tailored to my individual circumstances as opposed to being manualised therapy which I have had in the past. Precisely because I was not forced to change my symptoms, I could understand how they had developed and were being maintained and thus felt more motivated to change how I am with food and others, with my therapist standing alongside me.”

References:

Dare, C., Eisler, I., Russell, G., Treasure, J. & Dodge, L. (2001) Psychological therapies for adults with anorexia nervosa: randomized controlled trial of outpatient treatments. British Journal of Psychiatry, 178, 216-221.

Tanner, C. and Connan, F. (2003) Cognitive Analytic Therapy. In Treasure, J., Schmidt, U. & van Furth, E. Handbook of Eating Disorders. 2nd Ed.

Tanner, C. & Carolan. A. (2009) Audit of Cognitive Analytic Therapy Cases in Eating Disorders. Presented at the 2009 International ACAT conference. In Press.

Treasure, J. & Ward, A. (1997) Cognitive analytic therapy in the treatment of anorexia nervosa. Clinical Psychology and Psychotherapy, 4(1), 62-71.

Kumari Abeydeera